For a number of years it has been taught that coronary atherosclerosis in patients with fatal coronary heart disease was focal process, i.e., present in some coronary arteries and not present in others and present in some portions of one coronary artery and absent in other portions of the same coronary artery. This brief report summarizes observations in a number of patients with fatal coronary heart disease and emphasize that no portion of the extramural coronary arterial tree is void of atherosclerotic plaques in patients with fatal coronary heart disease.